Therapeutic, gravity actuated, sustained pressure applicator



Oct. 26, 1965 M. A. MULKIN 3,213,353

THERAPEUTIC, GRAVITY AGTUATED, SUSTAINED PRESSURE APPLICATOR Filed Sept. 11. 1961 IN V EN TQR. mar/0n A Walk zrmm ys. a

United States Patent 3,213,853 THERAPEUTIC, GRAVITY ACTUATED, SUS- TAINED PRESURE APPLICATOR Marion A. Mulkin, Fort Lauderdale, Fla. (5730 SW. 24th St., Miami, Fla.) Filed Sept. 11, 1961, Ser. No. 137,311 14 Claims. (Cl. 12869) This invention relates to therapeutic treatment apparatus, and more particularly, to apparatus for the application of therapeutic pressure to portions of the human anatomy, especially the paravertebral tissues.

Apparatus for applying the teohinque of reflex treatment of the spinal nerves of the human anatomy has been described in my prior U.S. Letters Patent No. 2,893,383, and entitled Therapeutic, Gravity Actuated, Sustained Pressure Applicator.

In the aforesaid patent, structure was provided for appying continuous pressure of substantial magnitude to the paravertebral tissues for a considerable period of time without release or variation to inhibit the musclar branch of the spinal nerve and the sympathetic chain ganglia. Although the structure of applying the aforesaid treatment and described in the above-mentioned patent has proven to be satisfactory in numerous cases, certain improvements to the structure have been found to be necessary, especially in the manner in which the weight is applied to the various portions of the human anatomy in the positioning of the weight relative to the patient to be treated and in the design of a base for supporting the patient and for counterbalancing the force of pulmonary expiration.

The present invention overcomes the shortcomings of the structure described in my aforesaid patent by permitting the weight applied to the patient to be varied in discrete increments to thereby attain a fine adjustment for the application of the weights to the patient and thereby overcome the problem of applying too much or too little weight inherent in the device of my prior patent.

To this end, the present invention includes a support adapted to be disposed adjacent the patient to be treated and specifically to be secured to the treatment table upon which the patient reclines, or upon a suitable movable floor base. An elongated arm is secured adjacent one end thereof to the uppermost extremity of the support and is mounted, by virtue of a universal coupling unit, for movement about a horizontal axis. In addition, the support is constructed to permit the arm to be raised and lowered to permit ready accommodation to patients of all sizes and, by means of movement parallel with the table, to allow more stable positioning thereof.

A patient-engagaing assembly of a predetermined weight is secured to the arm adjacent the opposite end thereof for applying pressure to the various portions of the anatomy of the patient by the action of gravity. The weights of the assembly and arm act along a vertical line through the assembly and, since the assembly engages the patient, the weights apply pressure to the point or area of the anatomy at which the assembly engages the same.

Means is provided for varying the weight applied to the patient and includes a shiftable weight carried by the arm for movement longitudinally thereof. The Weight may be slidably mounted within the arm, in which case the arm is tubular. However, the weight may be exteriorly mounted on the arm by circumscribing the same for movement between the ends thereof. In this latter case, the arm may well be an externally threaded screw threadably receiving the Weight or a cylinder slidably receiving a ring-shaped weight. The present embodiment of the 3,213,853 Patented Oct. 26, 1965 arm is a tubular configuration. In either case, the weight applied to the patient through the assembly may be varied in discrete increments which was impossible with the structure in my prior patent.

It is to be noted that the treatment table supports the weight means so that no large, heavy, floor supported base is required as is disclosed in my prior patent. The treatment table in the present disclosure overcomes the stability problems inherent in the base disclosed in said prior patent.

It is, therefore, the primary object of the present invention to provide apparatus for treating various parts of the human anatomy by the application oftherapeutic pressure through the utility of weight continuously directed to the parts under the action of gravity, and wherein the weighf may be varied in discrete increments to vary the pressure applied to the patient, depending upon the individual needs of the latter, whereby the apparatus is suitable for use in the aforesaid treatment for children and adults alike without applying too little or too much pressure to the parts to be treated, thus overcoming a problem inherent with devices heretofore utilized.

It is another object of the present invention to provide apparatus of the aforesaid character, wherein the weightmay be varied in discrete increments as the treatment is being continuously applied so that the treatment need not be interrupted in order to vary the pressure applied by changing the weights.

A further object of the present invention is the provision of apparatus for applying therapeutic pressure to the treatment of various parts of the anatomy of an individual, and wherein the structure for applying the pressure includes gravity-actuated weight means which is shiftable in substantially all directions, whereby the Weight means is shiftable with the anatomy contacted thereby when the anatomy expands and contracts during the respiration of the individual, thus eliminating the feeling in the individual of being pinned down by weights of devices heretofore utilized.

Another object of the present invention is the provision of apparatus for applying weight to parts of the anatomy of an individual to be treated, and wherein is included structure in the nature of an elongated tubular arm pivotal ly mounted on a support adjacent the individual and a Weight-applying, patient-engaging assembly secured to the arm adjacent the end thereof opposite to the end pivotal-' ly mounted on the support whereby the pressure-applying assembly forms a unit of a predetermined weight which is adapted to rest or be supported on the part of the individual to be treated and thus utilize the force of V gravity for applying the therapeutic pressure to the individaul. To this end, it is a further object of this invention to shiftably mount said pressure-applying assembly on said arm so that the assembly may be positioned over the spine of a patient, regardless of the angular, horizontal position of the arm relative to the patient.

Yet another object of the present invention is the provision of variable weight means on the aforesaid arm for varying the weight applied to the individual by one motion, utilizing the law of leverage whereby the treatment need not be interrupted as the weight is being varied, but may continue to thereby enhance the benefits received by the individual by an uninterrupted application of pressure thereon, to render much easier the weight-changing motion and to permit change of weight by smaller increments than heretofore ossible.

A further object of the present invention is the provi-' sion of universal joint means interconnecting the arm with the support, and for interconnecting the assembly with the arm, whereby the arm and assembly may assume a plurality of positions and, therefore, be readily positionable for patients of various sizes and for various portions of the anatomy of the same individual.

A still further object of the present invention is the provision of a support for the arm of the above-mentioned character which is provided with manual means thereon for raising, lowering and rotating the arm and, therefore, the assembly may be moved into and out of engagement with the individual without relaying upon external power means and elaborate control apparatus which have been required in devices heretofore utilized.

Other objects of the present invention will become apparent as the following specification progresses, reference being had to the accompanying drawings, wherein:

FIGURE 1 is a side elevational view of therapeutic apparatus which forms the subject of the present invention and illustrating the interconnection thereof with a treatment table for supporting a patient to be treated;

. FIG. 2 is a plan view of the therapeutic treatment apparatus and treatment table illustrated in FIG. 1;

FIG. 3 is a cross-sectional, fragmentary view of the therapeutic treatment apparatus and illustrating an elongated arm having shiftable weight means therein for varying the weight applied to the patient to be treated, and further illustrating the universal connection between a support mounted on the treatment table and the arm;

FIG. 4 is a cross-sectional view taken along line 4-4 of FIG. 3 and FIG. 5 is a fragmentary, cross-sectional view of one end of the arm illustrating another manner of coupling the weight means to said arm.

Therapeutic treatment apparatus broadly denoted by the numeral 10, includes a support 12, an elongated member in the nature of a tubular arm or rod 14 secured adjacent one end thereof to support 12, and a patient-engaging, pressure-applying assembly broadly denoted by the numeral 16 secured to arm 14 adjacent the opposite end of the latter.

Apparatus is adapted to be utilized for applying therapeutic pressure to various parts of the anatomy of an individual and to this end, apparatus 10 is utilized with a treatment table 18 serving through functional necessity as a base for support 12 and thereby arm 14. Table 18 is provided with a plurality of U-shaped legs 20 supporting a generally rectangular base 22 above the floor level 24. Base 22 may be trough-shaped for accommodating a pad 26 of resilient material, preferably in the nature of a cushion formed of polyester to assure comfort for the patient reclining thereon. This soft pad has been found to be necessary because of the amount of weight applied to the patient in a manner to be described.

Pad 26 is provided with an opening 28 therethrough which is alignable with a similar opening (not shown) in base 22. Opening 28 provides a space within which the face of the individual may be disposed when the patient is in a prone position on pad 26. Thus, the patient is allowed to breathe with the face directed downwardly and further, the discomfort to the patient in the neck region thereof, which is normally associated with the twisting of the neck as the patient is lying prone under pressure of considerable magnitude near the neck on pad 26, is over-come and substantially eliminated.

Support 12 comprises an elongated pipe 30 secured to the side of base 22 by a bracket 32. Pipe 30 'may be adjustably mounted on bracket 32 to thereby raise or lower pipe 30 relative to base 22. Bracket 32 could conceivably be a dolly on a track so the entire apparatus could be shifted along the table length. This would facilitate positioning, and also would enable a physician to slide the entire apparatus out of the way and use the table for other purposes.

An elongated, externally threaded screw 34 is inserted within pipe 30 and projects upwardly therefrom. A handwheel 36 is provided with an internally threaded collar 38 resting on the upper end of pipe 30 and in substantial mesh with the screw 34. By rotating handwheel 36, screw 34 may be raised or lowered relative to pipe 30. It is to be noted that pipe 30 is generally mounted on base 22 by bracket 32 intermediate the ends of base 22 to thereby be centrally located with respect to pad 26 and especially, to be in position to apply therapeutic pressure to the paravertebral tissues of an individual.

A hook 39 at one end of an elongated stretch 41 of rigid material, is received over the outer ring portion of handwheel 36 to prevent the latter, and thereby screw 34, from tipping toward pad 26 when arm 14 is swung over pad 26, and excessive weight is applied to the distal end of arm 14. A ring 43 is loosely fitted around pipe 30 adjacent the upper end thereof and means, such as a setscrew, maintains ring 43 at a fixed position on pipe 30.

Arm 14 is closed at the ends thereof by end walls 40 and 42. An elongated shaft 44 spans the distance between end walls 40 and 42 and is secured thereto substantially eoaxially of arm 14.

Arm 14 is further provided with an elongated slot 46 therein having terminal ends spaced from the corresponding end walls 40 and 42. A weight element 48 in the nature of a cylinder of lead or the like, is disposed within arm 14, and element 48 is provided with a bore 50 therethrough substantially coincident with the longitudinal axis thereof. Shaft 44 extends through bore 50 of element 48 and it is to be understood that bore 50 is slightly larger than the diameter of shaft 44. A portion of the element 48 adjacent the lowermost surface thereof, has been removed to present a space 58 to clear fastening means 68 securing support 12 to arm 14.

Weight element 48 is provided adjacent each end thereof on opposed sides of space 58 with a pair of recesses for receiving therein a pair of ball bearings 52, the latter normally engaging the inner surface of arm 14 to space shaft 44 inwardly of and out of engagement with element 48 within bore 50. Thus, element 48 may be readily moved relative to shaft 44, hindered only by the frictional force between arm 14 and ball bearings 52. However, in the event that shaft 44 engages element 48 within bore 50, shaft 44 is coated with a suitable material such as nylon or the like to reduce the friction between shaft 44 and element 48 and thus permit the latter to be more readily shiftable between the ends of arm 14.

A spirit level 54 is secured to the normally uppermost surface of arm 14 adjacent one end of slot 46 and support 12. Level 54 is filled with a liquid and provided with a window 56 through which an air bubble on the liquid may be observed to denote the degree of levelness of arm 14.

Arm 14 is provided with index marks 57 thereon adjacent slot 46 as is clear in FIG. 2, to represent, when arm 14 is calibrated, the increment of weight being applied to the patient as a result of the positioning of element 48 within tube 14. To facilitate the determination of the weight being applied by virtue of the positioning of element 48, tube 14 may conceivably be formed from transparent material such as lucite or the like, so that a central reference line marked on element 48 and denoting the center of gravity of the latter, may be readily observable through arm 14 and alignable with one of the index marks 57 thereon.

Element 48 is provided with a threaded bore (not shown) in the normally uppermost surface thereof for receiving a screw 62 which extends outwardly therefrom through slot 46. A head 64 is rigid to screw 62 and is provided with a hub 66 engageable with arm 14 on opposed sides of slot 46. As screw 62 moves out of element 48, hub 66 moves out of engagement with arm 14, thus permitting element 48 to be manually shifted longitudinally of arm 14. When screw 62 moves into element 48, hub 66 moves into engagement with arm 14 and thus locks element 48 in a fixed position within tube 14.

Means for interconnecting support 12 with arm 14 comprises a fork and tongue unit broadly denoted by the numeral 68. Unit 68 includes a ball 70 rigid to the uppermost end of screw 34 by means of a spacer 72. A socket device 74 complementally receives ball 70 and is secured by virtue of fastening means 60 to the underside of arm 14in spaced relationship to end wall 42 of the latter. Unit 68 rotates only about a horizontal axis to incline arm 14 relative to support 12.

Device 74 is provided with a pair of generally perpendicular surfaces 76 and 78 mounted on substantially diametrically opposed locations relative to ball 70. Surfaces 76 and 78 provide shoulders which abut the spacer 72 and the upper end of screw 34 respectively, when arm 14 is in vertical and horizontal positions respectively. As illustrated in FIGS. 1 to 3 inclusive, arm 14 is in the horizontal position and, in this position, surface 78 engages the upper end of screw 34 and surface 76 is spaced from spacer 72. When arm 14 is swung into a vertical position, surface 78 moves out of engagement with screw 34 and surface 76 moves into engagement with spacer 72. It is evident that surfaces 76 and 78 therefore, provide stops to limit the swinging movement of arm 14 to a 90 arc about a horizontal axis.

Assembly 16 comprises a generally polygonal component 80 in the nature of a rubber pad of a predetermined weight which is provided with a convex, patient-engaging surface 82. Although a convex surface for component 80 is illustrated, it is clear that the same may be concave or flat, or any combination of the three shapes, depending upon the needs and requirements of the patient to be treated. This type of pad is suitable since it can conform to generally all shapes of the anatomy.

A ball and socket coupling device 84 is secured to the upper surface 86 of component 80 and interconnects the latter with the lower end of the elongated rod 88 normally extending upwardly therefrom. Rod 88 is provided at the uppermost end thereof with a laterally extending flange portion 90 which is receivable within a groove 92 of a track member 94 secured in any suitable manner to the underside of arm 14. Track member 94 extends from end wall 40 toward end wall 42 and terminates substantially centrally of arm 14. Track member 94 is open at the end thereof adjacent end wall 40 to permit insertion and removal of rods 88 attached to components 80 of various shapes and sizes. By virtue of the aforesaid construction, component 80 may be shifted in a plurality of directions relative to arm 14 to thereby accommodate for the irregularity of the various parts of the human anatomy so that weight may be effectively applied to the aforesaid parts.

Before operation, the patient to be treated is disposed on pad 26 in a reclining position prior to the application of'weight thereto. Arm 14 is at a location with the longitudinal axis thereof substantially parallel with the longitudinal axis of pad 26 and with assembly 16 being proximal to the plane of the upper surface of pad 26. This allows the patient to move onto pad 26 without interference from arm 14 or assembly 16. It is to be understood that assembly 16 is initially positioned relative to pad 26 so that when arm 14 is swung to a position overlying pad 26 and the patient disposed thereon, arm 14 must be manually tipped upwardly to allow assembly 16 to move above the plane of pad 26 to clear the patient on the latter, whereupon the arm is lowered slightly so that assembly 16 moves onto the patient.

Arm 14 is then moved into overlying relationship to the patient on pad 26 and, at the same time, arm 14 is tipped upwardly to allow assembly 16 to move onto the patient. Handwheel 36 is then manipulated to raise screw 34 relative to pad 26 until arm 14 is substantially horizontal and surface 78 is slightly out of engagement with the upper end of screw 34. When this occurs, the combined weights of the assembly 16 and arm 14 act along a vertical line through assembly 16 under gravity and, therefore the weight in effect rests upon and is supported by the part of the anatomy engaged by assembly 16.

5 To vary the weight applied to the patient, element 48 is shifted longitudinally of arm 14 by shifting screw 62 outwardly from element 48 to permit the latter to shift along shaft 44. When the proper position of element 48 is attained, hub 66 moves into engagement with arm 14 to thereby lock element 48 in a fixed position. It is noted that the movement of element 48 can be accomplished even though assembly 16 engages the patient and therefore, the treatment can continue while shifting of element 48 takes place.

By virtue of the pivotal interconnection of arm 14 with support 12, arm 14 and thereby assembly 16, may pivot relative to screw 34 as the anatomy expands and contracts due to the respiration of the patient. It is, therefore, seen that assembly 16 and arm 14 breathe with the patient to thereby eliminate the feeling in the patient of being pinned down.

When it is desired to stop the treatment, arm 14 may be swung to a vertical position by manually raising the arm 14 until it rests in the vertical position. This permits the treatment to cease immediately and the patient may then move off pad 26. Also, handwheel 36 may be manipulated to shift screw 34 and thereby arm 14 upwardly until surface 78 once again contacts screw 34. Further movement of the screw 34 upwardly, permits assembly 16 to move out of engagement with the patient.

Another embodiment of the tubular arm and shiftable weight means therein is illustrated in FIG. 5, and the same includes a tubular arm 114 having an elongated screw 144 journalled at the ends thereof in opposed end walls 142 of arm 114 by virtue of bearings 145. A handwheel 147 is operably coupled to a projecting portion of screw 144 adjacent and exteriorly of one end wall 142 for rotating screw 144 relative to arm 114.

Arm 114 is provided with a slot 146 therethrough along the normally uppermost surface thereof in much the same manner as slot 46 in tube 14. A weight element 148 is disposed within arm 114 and is provided with an internally threaded bore (not shown) for receiving screw 144. A tab 149 is secured to element 148 and projects upwardly therefrom and passes through slot 146. Tab 149'prevents element 148 from rotating within arm 114 when screw 144 is caused to rotate under the influence of handwheel 147. Tab 149 may also serve as a reference mark in conjunction with index marks disposed on the upper surface of arm 114 adjacent slot 146.

Although handwheel 147 is utilized to manually rotate screw 144, it is conceivable that handwheel 147 may be replaced by a suitable electrically-actuated prime mover such as an electric motor, and suitable control means may be operably coupled to the prime mover for selectively moving element 148to various positions within arm 114. It is, therefore, evident that weight element 148 may either be moved by manual means or by remotely controlled means spaced from arm 114.

Although elements 48 and 148 may be manually and electrically shiftable, the same may further be hydraulically actuated by proper choice of mechanism to accomplish the same. In addition, assembly 16 may be provided with means for applying heat, either dry or moist, prior to, during, or after the application of pressure to the various parts of the human anatomy. Similarly, means may be operably coupled with pad 26 to produce ultrasonic waves or tactile vibratory motion or other stimulative means to the patient disposed on pad 26 prior to, during, or after the application of sustained pressure by assembly 16.

It is understood that variations in therapeutic use, in power employed, and in design or arrangement of parts may be made if such changes do not depart from the spirit of the invention. It will be understood that other modifications within the scope of the appended claims may be made in the design and arrangement of the parts without departing from the spirit of the invention.

Having thus described the invention, what is claimed as new and desired to be secured by Letters Patent is:

1. Therapeutic treatment apparatus comprising a support; an elongated, hollow member adapted to be disposed above a patient to be treated; means mounting said member for pivotal movement about a substantially horizontal axis toward and away from said patient; a patientengaging assembly carried by said member in depending relationship thereto, at least the major portion of the weights of said member and said assembly acting through said assembly to apply pressure to the patient when a patient is being treated; and means within said member and movable longitudinally thereof for varying the weight acting through said assembly to thereby vary the pressure applied to said patient.

2. Therapeutic treatment apparatus comprising an elongated support adapted to be mounted uprightly adjacent a patient to be treated; an elongated member; means on said support adjacent the upper end thereof and coupled with said member adjacent one end thereof for mounting said member above said patient for pivotal movement about intersecting horizontal and vertical axes; a patient-engaging assembly carried by said member in depending relationship thereto, at least the major portion of the weights of said member and said assembly acting through said assembly to apply pressure to the patient when a patient is being treated; and variable weight means on said member and movable longitudinally thereof for varying the weight acting through said assembly to thereby vary the pressure applied to said patient.

3. Therapeutic treatment apparatus as set forth in claim 2, wherein said means for mounting said member on said support comprises a ball and socket coupling device.

4. Therapeutic treatment apparatus as set forth in claim 3, wherein is included shoulder means on said coupling device to limit the pivotal movement of said member about said axes.

5. Therapeutic treatment apparatus comprising a support; an elongated, tubular arm pivotally mounted at one end thereof on said support and adapted to be disposed above a patient to be treated, said arm being movable toward and away from said patient; a patient-engaging assembly carried by said member in depending relationship thereto, said member and said assembly being disposed with at least the major portion of the weights thereof acting through said assembly to apply pressure to the patient when a patient is being treated; an element of predetermined weight within said member; and means coupled with the arm for shiftably mounting said element for movement between the ends of the arm to thereby vary the weight acting through the assembly and thereby the pressure applied to the patient.

6. Therapeutic treatment apparatus as set forth in claim 5, wherein said element mounting means includes an elongated shaft within said arm and rigidly secured thereto, said element being shiftably mounted on said shaft, and means on said element for shifting the latter relative to said shaft.

7. Therapeutic treatment apparatus as set forth in claim 6, said arm being provided with a longitudinally extending slot therein, and including extension means secured to said element and projecting outwardly therefrom through said slot, and element locking means on said extension means and engageable with said arm for releasably maintaining said element in a fixed position on said arm.

8. Therapeutic treatment apparatus as set forth in claim 7, said extension means including a screw, said locking means including a head threadably mounted on said screw.

9. Therapeutic treatment apparatus as set forth in claim 6, wherein is included bearing means secured to said element and normally in engagement with said arm 8 for spacing said element out of engagement with said arm.

10. Therapeutic treatment apparatus as set forth in claim 5, wherein said element mounting means includes an elongated screw coupled with said arm, said element being threadably mounted on said screw.

11. Therapeutic treatment apparatus comprising an elongated support adapted to be mounted uprightly adjacent a patient to be treated; an elongated member; means on said support adjacent the upper end thereof and coupled with said member adjacent one end thereof for mounting said member above said patient for pivotal movement about intersecting horizontal and vertical axes; a patient-engaging assembly; an elongated rod secured at one end thereof to said member adjacent the opposite end of the latter; and universal joint means on the opposite end of the rod interconnecting the latter with said assembly, said member and said assembly being disposed with at least the major portion of the weights thereof acting through said assembly to apply pressure to the patient when a patient is being treated; and variable weight means on said member and movable longitudinally thereof for varying the weight acting through said assembly to thereby vary the pressure applied to said patient as said member moves toward said patient about said horizontal axis.

12. Therapeutic treatment apparatus as set forth in claim 11, wherein said universal joint means comprises a ball and socket coupling device for pivoting said assembly about a horizontal axis, and including track means on said member and operably coupled with said rod for shiftably mounting the latter and thereby said assembly on said member.

13. Therapeutic treatment apparatus as set forth in claim 12, wherein said track means includes a grooved track member secured to and extending longitudinally of said member, said rod being shiftably mounted at one end thereof within said groove.

14. Therapeutic treatment apparatus comprising a support including base structure, an elongated screw, and means coupling said screw with said base structure for movement relative to the latter, said base structure being adapted to be mounted adjacent a patient to be treated; an elongated member; means on said screw adjacent the upper end thereof and coupled with said member adjacent one end thereof for mounting said member above said patient for pivotal movement about intersecting horizontal and vertical axes; a patient-engaging assembly carried by said member in depending relationship thereto, said member and said assembly being disposed with at least the major portion of the weights thereof acting through said assembly to apply pressure to the patient when a patient is being treated; and variable weight means on said member and movable longitudinally thereof for Varying the weight acting through said assembly to thereby vary the pressure applied to said patient as said member moves toward said patient about said horizontal axis.

References Cited by the Examiner UNITED STATES PATENTS 787,168 4/05 Gibson.

978,760 12/ 10 Langworthy 128-71 1,386,901 8/21 Schreiner 128-73 1,457,093 5/23 Taplin 128-72 1,640,519 8/27 Schaeifer 128-69 2,109,577 3/38 Politis 128-69 2,658,506 11/53 Haskell 128-75 2,893,383 7/59 Mulkin 128-68 RICHARD A. GAUDET, Primary Examiner.

ROBERT E. MORGAN, Examiner. 

2. THERAPEUTIC TREATMENT APPARATUS COMPRISING AN ELONGATED SUPPOR ADAPTED TO BE MOUNTED UPRIGHTLY ADJACENT A PATIENT TO BE TREATED; AN ELONGATED MEMBER; MEANS ON SAID SUPPORT ADJACENT THE UPPER END THEREOF AND COUPLED WITH SID MEMBER ADJACENT ONE END THEREOF FOR MOUNTING SAID MEMBER ABOVE SAID PATIENT FOR PIVOTAL MOVEMENT ABOUT INTERSECTING HORIZONTAL AND VERTICAL AXES; A PATIENT-ENGAGING ASSEMBLY CARRIED BY SAID MEMBER IN DEPENDING RELATIONSHIP THERETO, AT LEAST THE MAJOR PORTION OF THE WEIGHTS OF SAID MEMBER AND SAID ASSEMBLY ACTING 